The downgrade came amid reports that West Penn, health insurer and potential new owner Highmark and West Penn bondholders tentatively agreed to a deal that would prevent the health system from filing for bankruptcy.

Fitch dropped West Penn's rating to "C", which is the lowest rating before an entity defaults, saying the "negotiated debt restructuring appears to be inevitable to forestall insolvency, given [West Penn's] financial deterioration and the failure of [West Penn] and Highmark to complete a proposed merger."

West Penn still has not released audited financial statements for its most recent fiscal year, which were due in December. Although West Penn has still been paying down its debt, the health system's bond trustee issued a notice of default, ordering the health system to release audited financials by the end of the month.